Mouth and Throat Flashcards by Jessica H

Main etiologies of acute pharyngitis? What percent receive abx?

Viral: 50%
Group A strep: 5-15%
Other: allergies, smokers

60% receive abx

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Sx of acute pharyngitis

sore throat
fever
HA
malaise
"swollen glands"
URI sx

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PE findings of acute pharyngitis

pharyngeal erythema
tonsillar hypertrophy
purulent exudate
tender anterior cervical lymph nodes
palatal petechiae

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What do you do in diagnosing acute pharyngitis? (Need to exclude?)

Exclude GABHA pharyngitis

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Tx of acute pharyngitis

supportive tx

reassess if no improvement in 5-7 days or if worsens

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Clinical presentation of GABHS

sudden onset ST
tonsillar exudate
tender cervical adenitits
fever
cough ABSENT

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Centor criteria:

what are the guidelines

0-1: not likely
2-3: need to do Rapid strep test or culture
4: treat with abx

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What does a negative RADT mean?

does not indicate negative for strep, need to follow-up with culture

not very sensitive (70-90%)

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How do you treat GABHS?

Penicillin V 500 mg PO TID- TID x 10 days

Amoxicillin 500 mg BID x 10 days*
penicillin G benzathine 1.2 million unitis IM single dose
Cephalexin 500 mg PO BID x 10 days

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How can you treat a patient with GABHS who is allergic to penicillin?

Macrolides- (erythromycin, clarithromycin, Azithromycin)

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Complications of GABHS

Acute rheumatic fever
acute glomerulonephritis

others:
Scarlet fever
peritonsillar abscess
OM
mastoiditis 
bacteremia

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Based on Paradise Criteria for Tonsillectomy, who is a good candidate for tonsillectomy?

Pt w/ at least 7 episodes in the last year or at least 5 episodes in each of the past 2 years or 3 episodes in each of the past 3 years

ST plus fever >100.9 or tonsillar exudate or anterior cervical adenopathy or culture confirmed GABHS

Appropriate abx tx for strep episodes

recommend 12 month obs period

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Most common deep neck infection in children/adolescents?

peritonsillar abscess

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Predominent species in peritonsillar abscess

Streptococcus pyogenes (GABHS)

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Sx of peritonsillar abscess

severe sore throat
fever
“hot potato” or muffled voice

drooling
trismus
neck swelling/pain
ipsilateral ear pain
decrease PO intake

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PE findings in peritonsillar abscess

swollen, fluctuant tonsil w/ deviation of uvula to the opposite side
fullness/bulging of posterior soft palate
cervical LAD

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How do you dx peritonsillar abscess?

clinical!

labs you can check:

cbc
electrolytes
throat culture
culture of abscess

imaging:
-CT w/ IV contrast

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Tx of peritonsillar

monitor for airway obstruction
drainage

-antimicrobial therapy:
parenteral ampicillin-sulbactam or clindamycin
oral: amoxicillin-clavulanate or clindamycin x 14 days

-supportive care

+/- hospitalization

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Infectious cause of laryngitis?

Respiratory viruses!
rhinovirus, influenza, parainfluenza

Others:
bacterial
noninfectious cause (vocal abuse, GERD)

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Main complaint in laryngitis

Hoarseness

URI sx- rhinorrhea, congestion, cough, ST

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Tx of laryngitis, length?

treat underlying cause
(humidification, voice rest including no whispering, hydration, avoid smoking)

usually resolves in 1-3 weeks

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Most common cause of epiglottitis? who is at risk?

Haemophilus influenza type B

strep
S. aureus

incomplete or non vaccinated
immunodeficiency

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3 D’s of epiglottitis? Others?

dysphasia, distress, drooling

"tripod" or "sniffing" position
fever
respiratory distress
odynophagia- pain out of proportion
muffled speech

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If a pt develops anxiety when trying to visualize epiglottitis what do you do?

Stop!
risk of airway obstruction
make sure you are able to intubate if needed

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What is the classic sign seen on lateral plain radiograph in epiglottitis?

"thumb sign"

Tx of epiglottitis? Prevention?

medical emergency airway protection hospitalization IV abx- 3rd gen cephalosporin & antistaphylococcal (vancomycin) Prevention= immunization

Clinical presentation of HSV? How long does it last?

sudden onset of multiple vestibular lesions on inflamed, erythematous base 10-14 days initial 5 day recurrent

What are triggers of HSV?

``` sunlight fever menstruation stress trauma ```

How do you dx HSV?

clinical viral culture serology immunofluorescence microscopy for antigens

How do you treat HSV?

antivirals analgesics fluid management

When do you see herpetic gingivostomatitis? What is it?

in Primary HSV infection ulcerative lesions of gingiva and mucus membrane of mouth often w/ personal vesicular lesions

What is coxsackie virus? (other name, common population, etiology, sx, dx/tx)

Hand foot and mouth common in children coxsackie A16 - prodrome: low-grade fever, malaise, abd pain, URI sx - painful oral lesions- PAPULES on erythematous base dx/tx: clinical supportive care

How do you distinguish Hand foot mouth from Herpangia?

Hand foot mouth: - low grade fever - papules on tongue and hard palate Herpangia: - higher fever - lesions more posterior (soft palate)

Aphthous ulcers: associated with?

HHV-6 | also seen in celiac dz, IBD, HIV

Where are aphthous ulcers found? how do you describe them?

gums, tongue, lips, palate, buccal mucosa painful, small, shallow, round ulcers with gray base surrounded by red halo

What are aphthous ulcers triggered by? How do you treat?

triggered by stress topical corticosteroids in adhesive base topical analgesics

What is Bechet's? How do pt's present? | Dx/Tx?

inflammatory disorder recurrent oral and genital aphthae Dx: recurrent oral ulcers > 3 x per year + other clinical findings (eye lesions or skin lesions) Tx: refer to rheumatologist

Who are classic patients with oral candidiasis?

infants and older adults (dentures)

Risk factors for oral candidiasis

``` dentures poor oral hygiene DM anemia corticosteroid use abx use HIV ```

Presentation of oral candidiasis? | Important question to ask?

painful, creamy-white, curd-like patches over erythematous mucosa cotton mouth does it brush off? "Thrush will brush"!

If unsure if pt has oral candidiasis, what do you do?

normally clinical, but can do KOH wet prep (looking for budding yeast)

Tx of oral candidiasis?

antifungal- start with topical - clotrimazole troches - nystatin mouth rinses

What is Oral Lichen planus? How does it present? | How do you dx/tx?

chronic, inflammatory autoimmune disease presents in many ways! (reticular white plaques, mural erythema, erosions) ``` dx= biopsy tx= manage pain/discomfort (corticosteroids, cyclosporines, retinoids) ```

How can you differentiate oral leukoplakia from thrush?

white lesions in oral leukoplakia cannot be removed by scraping!

What is oral leukoplakia?

hyperplasia of squamous epithelium from chronic irritation precancerous! can be a/w HPV

How are the lesions describes in Erythroplakia?

red, velvety plaque-like lesion

What do Erythroplakia represent? What must be done?

>90% represent a malignant change all must be biopsied, refer to ENT

What causes Hairy Leukoplakia? What population?

EBV pts with HIV

Describe the presentation of Hairy Leukoplakia

lateral tongue white, painless plaque, cannot be scraped not considered premalignant

What are Mucoceles? | how do you treat?

fluid filled cavities w/ mucous glands lining the epithelium - may rupture spontaneously - remove w/ cryotherapy or excision of entire cyst

Where are amalgam tattoos seen, indicating not a melanoma?

seen adjacent to amalgam filling (metal used in dental fillings)

what are torus palatinus?

benign boney lesions | normally on hard palate

Bacteria that causes dental caries

strep mutans

What is Sialolithiasis? | Where does it occur most often?

stone and/or inflammation within the salivary glands or ducts stones occur in Wharton duct

What are possible sx in a pt with Sialolithiasis?

- acute swelling | - increased pain with eating

Tx of Sialolithiasis

- hydrate, heat, massage, "milk" the duct - sialagogues - nsaids

What is suppurative parotitis and what is the clinical presentation?

acute infection of parotid gland - sudden onset of firm, erythematous swelling or pre/postauricular areas - severe pain/tenderness - trismus

What is the most important thing to be aware of in a pt with possible Ludwig's angina?

Airway compromise! most common neck space infection( from tooth infection)

Most common type of oral cancer?

squamous cell carcinoma (>90%)

If a pt comes in complaining of oral ulcers or masses that do not seem to heal, what diagnosis should you be thinking of?

Squamous cell carcinoma

What strains of HPV are a/w SCC of the tongue, tonsil, and pharynx?

Types 16, 18, and 31

Hoarseness from laryngitis should last how long? | If it lasts longer, what do you do?

Hoarseness from laryngitis should last 1-3 weeks Anything longer than 3 weeks needs to be visualized (laryngoscopy by ENT) Anything 6 weeks or longer should be consider cancer until proven otherwise